Shuttleworth PLLC member Bruce Williams spoke on October 4, 2013, to the Annual Mid-South Workers’ Compensation Association Conference to claim managers, human resource officers and nurse case managers on the topic “Avoiding Common Claim Management Mistakes: Denial, Delay and Disorder.”
The presentation provided strategies for properly denying claims with medical evidence, providing proper Physician Panels, identifying the hazards of Utilization Review, use of strategic second medical opinions, employment of nurse case managers, good communication techniques with the claimant and doctors, and ways to avoid the upcoming increases in penalty assessment from the Tennessee Division of Workers’ Compensation.
By Bruce Williams
Under legislation signed into law and effective June 6, 2011, the opinion of the physician selected by the employee from a panel of three employer-designated physicians shall be presumed correct on the issue of causation (whether the workcaused the condition in an incident or incidents identifiable by time and place). This presumption may be challenged by another doctor, but the employer’s panel doctor is rebuttably presumed to be correct on causation.
Cumulative trauma conditions such as hearing loss, carpal tunnel syndrome, and other repetitive motion injuries (“gradual injuries”) are not deemed work related unless the panel doctor says the condition “primarily” arose out of and in the course of the employment. Again, another doctor can attempt to challenge afinding by the panel doctor, but the panel doctor is rebuttably presumed to be correct, i.e. unless the authorized doctor is felt to be wrong with a reason demonstrated in evidence, the judge is bound to accept the employer‐authorized doctor’s opinion. This makes the need for compliance with the Dept. of Labor Rules on offering medical care for work injuries all the more important.
The employer must use theC‐42 Panel of Physicians Form and get the employee to sign the form after the employee makes his/her choice of treating doctor from the panel of threephysicians (five choices including a chiropractor for claims of back injury). If the employer does not provide a proper panel, using proper paperwork offered on a timely basis, an otherwise good defense to the claim will be forfeited. Under this law change, the employer takes a great risk in denying a claim without having the employee evaluated by a panel doctor chosen by the employee, so that the employer has the benefit of the authorized doctor’s opinion oncausation, and whether the condition “primarily” relates to the work.
For more information on the new Tennessee requirements, call Bruce Williams at 901-328-8236.